Pediatric Acute Care Nurse Practitioner Mastery
Test Bank: 150 Practice Questions, Answers And
Rationale
2025/2026
1. A 3-year-old presents with high fever, drooling, and stridor. Which
is the most likely diagnosis?
A. Croup
B. Epiglottitis
C. Bronchiolitis
D. Asthma
B. Epiglottitis
Rationale: Epiglottitis presents with sudden onset fever,
drooling, stridor, and respiratory distress. Immediate airway
management is critical.
2. A 6-month-old infant has a temperature of 101.8°F, irritability,
and poor feeding. There is no localizing sign. What is the next best
step?
A. Treat with acetaminophen at home
B. Obtain a full septic workup
C. Reassure the parents
D. Prescribe oral antibiotics
B. Obtain a full septic workup
Rationale: Infants under 12 months with fever without a source
are at high risk for serious bacterial infection and require a full
septic workup.
3. A 5-year-old presents with a “barking” cough and inspiratory
stridor. Which treatment is first-line?
, A. Oral antibiotics
B. Nebulized epinephrine
C. Oral corticosteroids
D. Humidified air and supportive care
C. Oral corticosteroids
Rationale: Mild to moderate croup responds to oral
corticosteroids. Nebulized epinephrine is reserved for severe
respiratory distress.
4. A 2-week-old infant presents with jaundice. Total bilirubin is 18
mg/dL. What is the next step?
A. Phototherapy
B. Exchange transfusion
C. Repeat labs in 24 hours
D. No intervention
A. Phototherapy
Rationale: Neonatal jaundice with total bilirubin >15–18 mg/dL
in the first two weeks warrants phototherapy to prevent
kernicterus.
5. Which vaccine is contraindicated in an immunocompromised
child?
A. Inactivated influenza
B. MMR
C. Hepatitis B
D. DTaP
B. MMR
Rationale: MMR is a live attenuated vaccine and should not be
given to immunocompromised children.
6. A 4-year-old with sickle cell disease presents with fever of 102°F.
What is the most appropriate initial management?
, A. Outpatient observation
B. Immediate IV antibiotics
C. Oral antibiotics
D. Symptomatic care only
B. Immediate IV antibiotics
Rationale: Children with sickle cell disease are at high risk for
sepsis and require prompt empiric IV antibiotics.
7. A 7-year-old presents with a sudden onset of wheezing after
playing with a balloon. What is the most likely cause?
A. Asthma exacerbation
B. Foreign body aspiration
C. Viral bronchiolitis
D. Pneumonia
B. Foreign body aspiration
Rationale: Sudden onset of wheezing in a previously healthy
child suggests foreign body aspiration; imaging and possible
bronchoscopy are indicated.
8. Which congenital heart defect is most commonly associated with
Down syndrome?
A. Tetralogy of Fallot
B. Ventricular septal defect
C. Patent ductus arteriosus
D. Atrioventricular septal defect
D. Atrioventricular septal defect
Rationale: AV septal defects are strongly associated with Down
syndrome, often presenting with heart failure in infancy.
9. A 2-year-old presents with diarrhea and mild dehydration. What is
the first-line treatment?
A. IV fluids
, B. Oral rehydration therapy
C. Antibiotics
D. Antidiarrheal medications
B. Oral rehydration therapy
Rationale: Mild dehydration in children is best treated with oral
rehydration solutions, which are effective and safe.
10. A 6-month-old presents with a history of choking and
cyanosis while feeding. What is the most likely diagnosis?
A. Gastroesophageal reflux
B. Tracheoesophageal fistula
C. Laryngomalacia
D. Aspiration pneumonia
B. Tracheoesophageal fistula
Rationale: Neonates with choking, cyanosis, and feeding
difficulty should be evaluated for tracheoesophageal fistula.
11. A 3-year-old presents with fever, rash on cheeks (“slapped
cheek”), and mild cold symptoms. What is the likely cause?
A. Measles
B. Rubella
C. Parvovirus B19
D. Roseola
C. Parvovirus B19
Rationale: Fifth disease presents with a characteristic “slapped
cheek” rash and mild systemic symptoms.
12. Which of the following is the most common cause of
bronchiolitis in infants?
A. Influenza virus
B. Respiratory syncytial virus (RSV)
C. Parainfluenza virus
Test Bank: 150 Practice Questions, Answers And
Rationale
2025/2026
1. A 3-year-old presents with high fever, drooling, and stridor. Which
is the most likely diagnosis?
A. Croup
B. Epiglottitis
C. Bronchiolitis
D. Asthma
B. Epiglottitis
Rationale: Epiglottitis presents with sudden onset fever,
drooling, stridor, and respiratory distress. Immediate airway
management is critical.
2. A 6-month-old infant has a temperature of 101.8°F, irritability,
and poor feeding. There is no localizing sign. What is the next best
step?
A. Treat with acetaminophen at home
B. Obtain a full septic workup
C. Reassure the parents
D. Prescribe oral antibiotics
B. Obtain a full septic workup
Rationale: Infants under 12 months with fever without a source
are at high risk for serious bacterial infection and require a full
septic workup.
3. A 5-year-old presents with a “barking” cough and inspiratory
stridor. Which treatment is first-line?
, A. Oral antibiotics
B. Nebulized epinephrine
C. Oral corticosteroids
D. Humidified air and supportive care
C. Oral corticosteroids
Rationale: Mild to moderate croup responds to oral
corticosteroids. Nebulized epinephrine is reserved for severe
respiratory distress.
4. A 2-week-old infant presents with jaundice. Total bilirubin is 18
mg/dL. What is the next step?
A. Phototherapy
B. Exchange transfusion
C. Repeat labs in 24 hours
D. No intervention
A. Phototherapy
Rationale: Neonatal jaundice with total bilirubin >15–18 mg/dL
in the first two weeks warrants phototherapy to prevent
kernicterus.
5. Which vaccine is contraindicated in an immunocompromised
child?
A. Inactivated influenza
B. MMR
C. Hepatitis B
D. DTaP
B. MMR
Rationale: MMR is a live attenuated vaccine and should not be
given to immunocompromised children.
6. A 4-year-old with sickle cell disease presents with fever of 102°F.
What is the most appropriate initial management?
, A. Outpatient observation
B. Immediate IV antibiotics
C. Oral antibiotics
D. Symptomatic care only
B. Immediate IV antibiotics
Rationale: Children with sickle cell disease are at high risk for
sepsis and require prompt empiric IV antibiotics.
7. A 7-year-old presents with a sudden onset of wheezing after
playing with a balloon. What is the most likely cause?
A. Asthma exacerbation
B. Foreign body aspiration
C. Viral bronchiolitis
D. Pneumonia
B. Foreign body aspiration
Rationale: Sudden onset of wheezing in a previously healthy
child suggests foreign body aspiration; imaging and possible
bronchoscopy are indicated.
8. Which congenital heart defect is most commonly associated with
Down syndrome?
A. Tetralogy of Fallot
B. Ventricular septal defect
C. Patent ductus arteriosus
D. Atrioventricular septal defect
D. Atrioventricular septal defect
Rationale: AV septal defects are strongly associated with Down
syndrome, often presenting with heart failure in infancy.
9. A 2-year-old presents with diarrhea and mild dehydration. What is
the first-line treatment?
A. IV fluids
, B. Oral rehydration therapy
C. Antibiotics
D. Antidiarrheal medications
B. Oral rehydration therapy
Rationale: Mild dehydration in children is best treated with oral
rehydration solutions, which are effective and safe.
10. A 6-month-old presents with a history of choking and
cyanosis while feeding. What is the most likely diagnosis?
A. Gastroesophageal reflux
B. Tracheoesophageal fistula
C. Laryngomalacia
D. Aspiration pneumonia
B. Tracheoesophageal fistula
Rationale: Neonates with choking, cyanosis, and feeding
difficulty should be evaluated for tracheoesophageal fistula.
11. A 3-year-old presents with fever, rash on cheeks (“slapped
cheek”), and mild cold symptoms. What is the likely cause?
A. Measles
B. Rubella
C. Parvovirus B19
D. Roseola
C. Parvovirus B19
Rationale: Fifth disease presents with a characteristic “slapped
cheek” rash and mild systemic symptoms.
12. Which of the following is the most common cause of
bronchiolitis in infants?
A. Influenza virus
B. Respiratory syncytial virus (RSV)
C. Parainfluenza virus
